Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.
Neurosurg Rev. 2020 Apr;43(2):555-564. doi: 10.1007/s10143-018-1054-x. Epub 2018 Nov 27.
To evaluate the safety and efficacy of intradural "limited drill" technique (ILDT) of anterior clinoidectomy (AC) and optic canal unroofing (OCU) for microneurosurgical management of ophthalmic segment and posterior communicating artery (PCOM) aneurysms. All the patients with ophthalmic segment and PCOM aneurysms who underwent AC and OCU by ILDT for microneurosurgical management of ophthalmic segment and PCOM aneurysms during 4-year period (2013-2016) at our Institute were included in this study. In ILDT of AC and OCU, the use of power drill is restricted to AC only and OCU is done exclusively with 1-mm Kerrison punch. AC and OCU by ILDT were done in 24 patients with 29 ophthalmic segment and 7 PCOM aneurysms. AC and OCU by ILDT helped in mobilization of optic nerve/internal carotid artery (ICA) and provided excellent exposure for all these aneurysms. There was no injury to ICA or optic nerve during drilling. AC and OCU facilitated clip ligation of 34 of these aneurysms. Remaining 2 aneurysms were considered not suitable for clipping. Check angiogram done for 33 aneurysms revealed complete obliteration of 26 aneurysms, very small residual neck in 5 aneurysms, and small residual aneurysm in 2 aneurysms. Deterioration in vision was noted in 1 patient (4.1%). In 6 patients with preoperative visual deficits, significant improvement in vision was noted in 4 patients (4/6-66.6%) after surgery. Good outcome (MRS < 2) was noted in 91.6% (22/24) of these patients. ILDT is a safe and effective technique of AC and OCU which provide good exposure for ophthalmic segment and PCOM aneurysms.
评估颅内“有限钻孔”技术(ILDT)在前床突切除术(AC)和视神经管减压术(OCU)治疗眼段和后交通动脉(PCOM)动脉瘤的安全性和有效性。本研究纳入了 2013 年至 2016 年期间在我院采用 ILDT 行 AC 和 OCU 治疗眼段和 PCOM 动脉瘤的 24 例患者,共 29 个眼段动脉瘤和 7 个 PCOM 动脉瘤。在 ILDT 行 AC 和 OCU 中,仅将动力钻用于 AC,而仅使用 1mm 科里森冲头进行 OCU。ILDT 行 AC 和 OCU 有助于视神经/颈内动脉(ICA)的移动,并为所有这些动脉瘤提供了极好的显露。在钻孔过程中没有损伤 ICA 或视神经。AC 和 OCU 有助于夹闭这些动脉瘤中的 34 个。其余 2 个动脉瘤被认为不适合夹闭。对 33 个动脉瘤进行的复查血管造影显示,26 个动脉瘤完全闭塞,5 个动脉瘤残留小颈,2 个动脉瘤残留小动脉瘤。1 例患者(4.1%)视力下降。在术前视力下降的 6 例患者中,4 例(4/6-66.6%)患者术后视力显著改善。这些患者中有 91.6%(22/24)预后良好(MRS<2)。ILDT 是一种安全有效的 AC 和 OCU 技术,可为眼段和 PCOM 动脉瘤提供良好的显露。
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